Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men

We sought to identify the determinants of sexual transmission risk behavior by HIV-positive individuals. We examined social cognitive theory (SCT) variables, which have been found to mediate the effectiveness of HIV risk reduction interventions. We also sought to identify contextual influences that might contribute to initial levels of SCT factors such as self-efficacy. In the present study, a series of social cognitive variables and a number of factors hypothesized to influence self-efficacy were assessed among participants at baseline in the Seropositive Urban Men's Intervention Trial. Variables tested for their effects on self-efficacy included hedonistic and self-evaluative outcome expectancies, sexual compulsivity, a history of childhood sexual abuse, drug use, and race. Models predicting condom use during anal sex with partners of HIV-negative or unknown status were tested separately for main partners and for non-main partners. Self-efficacy was associated with condom use in both analyses. Contextual influences on condom use with main partners were fewer and operated mostly via effects on self-efficacy. Influences on condom use with non-main partners exerted both direct effects on condom use and effects mediated by self-efficacy. Drug use was predictive of condom use with non-main, but not main, partners. The present results support the approach of addressing both standard SCT factors, and when possible contextual factors in interventions for HIV-positive men.